Combination respiratory therapy device, system and method

ABSTRACT

A combination respiratory therapy management system creates a combined respiratory therapy prescription that can be executed by a combined respiratory therapy device to provide multiple coordinated respiratory therapies to a patient. The system can update the combined respiratory therapy prescription and implement the updates while the combined respiratory therapy device is in use. Some versions of the system provide additional features that allow the combined respiratory therapy prescriptions to be created, accessed, shared with other users, and performed by the combination respiratory therapy device in a customizable user-friendly and non-threatening way.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.13/692,192 filed Dec. 3, 2012, now U.S. Pat. No. 9,795,752, which isincorporated by reference herein in its entirety.

BACKGROUND

Patients with neuromuscular weakness as a result of strokes, spinal cordinjuries, head trauma, or diseases such as muscular dystrophy andamyotrophic lateral sclerosis (ALS, or Lou Gehrig's disease) have anincreased risk of morbity and mortality due to a weak cough and shallowbreathing (hypoventilation). The number of chronic illnesses that causeweak cough and impaired lung ventilation is large and expanding.

When a patient has an ineffective cough, chest secretions are retainedin the respiratory system, causing pneumonia, lung collapse, or, wherethe mucus fills the windpipe, fatal respiratory arrest. Additionally,shallow breathing causes low oxygen levels and high carbon dioxidelevels in the patient's bloodstream, resulting in a medically fragilestate of chronic respiratory failure in which even a common cold canresult in severe respiratory illness. For these reasons, pulmonarycomplications are viewed as a major cause of morbidity and death inpatients that have neuromuscular weakness.

As a patient's condition worsens, it becomes more likely that thepatient will need both cough assistance and assisted ventilation.Respiratory therapies for addressing a weak cough often involve devicesthat provide assisted coughing via mechanical insufflation/exsufflation,while shallow breathing is commonly addressed by a separate, mechanicalventilation device.

SUMMARY

According to at least one aspect of this disclosure, a combinationrespiratory therapy prescription creator embodied in one or moremachine-accessible storage media is executable by a computing device toreceive data indicating a respiratory condition of a person; determine,based on the respiratory condition, a combination of pre-definedrespiratory therapies from a plurality of possible therapies, thepossible therapies including lung ventilation, lung volume recruitment,mucus extraction, and mucus mobilization therapies; select a combinationrespiratory therapy device from a family of combination respiratorytherapy devices based on the determined combination of therapies, whereeach of the combination respiratory therapy devices includes a pluralityof separate interfaces that are engageable with the person to provide acombination of lung ventilation therapy or lung volume recruitmenttherapy and mucus extraction therapy or mucus mobilization therapy; andbased on the respiratory condition, create a respiratory therapyprescription to be executed by the selected combination respiratorytherapy device without disengaging the selected combination respiratorytherapy device from the person, the respiratory therapy prescriptionspecifying at least a lung ventilation or a lung volume recruitmenttherapy and a mucus extraction therapy and/or a mucus mobilizationtherapy to be provided by the selected combination respiratory therapydevice to the person.

The combination respiratory therapy prescription creator may beexecutable by a computing device to define a treatment session to beexecuted by the selected combination respiratory therapy device, wherethe treatment session includes a treatment sequence and the treatmentsequence includes a mucus extraction therapy substantially immediatelyfollowed by a lung ventilation therapy or a lung volume recruitmenttherapy.

The combination respiratory therapy prescription creator may specify anumber of times the treatment sequence is to be repeated during thetreatment session and define a duration of the treatment session basedon the number of times the treatment sequence is to be repeated. Thecombination respiratory therapy prescription creator may define a timeat which the mucus mobilization therapy is to be executed by theselected combination respiratory therapy device prior to the executionof the treatment session. The combination respiratory therapyprescription creator may define a time at which another lung ventilationor lung volume recruitment therapy is to be executed by the selectedcombination respiratory therapy device after the execution of thetreatment session. The combination respiratory therapy prescriptioncreator may define another treatment session to be executed by theselected combination respiratory therapy device prior to the executionof the treatment session. The other treatment session may include adifferent treatment sequence.

The combination respiratory therapy prescription creator may define atreatment session to be executed by the selected combination respiratorytherapy device, where the treatment session includes a plurality oftreatment sequences and each treatment sequence includes a mucusextraction therapy substantially immediately followed by a lungventilation therapy or a lung volume recruitment therapy. Thecombination respiratory therapy prescription creator may define themucus extraction therapy as a plurality of cough cycles that areconsecutively repeated by the selected combination respiratory therapydevice and define each cough cycle as including an application ofpositive-pressure air flow by the selected combination respiratorytherapy device followed by an application of negative-pressure air flowby the selected combination respiratory therapy device. The combinationrespiratory therapy prescription creator may define a duration of timefor which the lung ventilation therapy or lung volume recruitmenttherapy is performed by the selected combination respiratory therapydevice.

The combination respiratory therapy prescription creator may specify anaudio message to be played by the selected combination respiratorytherapy device at a time prior to the combination respiratory therapydevice performing the combination respiratory therapy prescription. Thecombination respiratory therapy prescription creator may associate adigital graphic or animation of a user-selected mascot with the audiomessage.

The combination respiratory therapy prescription creator may receivedata relating to a change in the person's respiratory condition andmodify the respiratory therapy prescription based on the data relatingto the change in the person's respiratory condition. The combinationrespiratory therapy prescription may define a treatment session to beperformed by the selected combination respiratory therapy device, definea time interval after which the treatment session is to be performed,receive data relating to a change in the person's respiratory condition,and change the time interval based on the data relating to the change inthe person's respiratory condition. The combination respiratory therapyprescription creator may define a treatment session to be performed bythe selected combination respiratory therapy device, where the treatmentsession comprises a treatment sequence and the treatment sequencecomprises a mucus extraction therapy followed by a lung ventilationtherapy or a lung volume recruitment therapy; receive data relating to achange in the person's respiratory condition; and add a mucusmobilization therapy to the respiratory therapy prescription based onthe change in the person's respiratory condition. The combinationrespiratory therapy prescription creator may define a treatment sessionto be performed by the selected combination respiratory therapy device,where the treatment session comprises a treatment sequence and thetreatment sequence comprises a mucus extraction therapy followed by alung ventilation therapy or a lung volume recruitment therapy; receivedata relating to a change in the person's respiratory condition; and addanother lung ventilation therapy or lung volume recruitment therapyfollowing the treatment session based on the change in the person'srespiratory condition. The combination respiratory therapy prescriptioncreator may define a treatment session to be performed by the selectedcombination respiratory therapy device, where the treatment sessioncomprises a treatment sequence and the treatment sequence comprises amucus extraction therapy followed by a lung ventilation therapy or alung volume recruitment therapy; receive data relating to a change inthe person's respiratory condition; and increase an inspiratory pressureassociated with the mucus extraction therapy based on the change in theperson's respiratory condition.

The combination respiratory therapy prescription creator may define atreatment session to be performed by the selected combinationrespiratory therapy device, where the treatment session includes atreatment sequence and the treatment sequence includes a mucusextraction therapy followed by a lung ventilation therapy or a lungvolume recruitment therapy; receive data relating to a change in theperson's respiratory condition; and increase an expiratory pressureassociated with the mucus extraction therapy based on the change in theperson's respiratory condition.

The combination respiratory therapy prescription creator may define atreatment session to be performed by the selected combinationrespiratory therapy device, where the treatment session includes atreatment sequence to be repeated a number of times during the treatmentsession and the treatment sequence includes a mucus extraction therapyfollowed by a lung ventilation therapy or a lung volume recruitmenttherapy; receive data relating to a change in the person's respiratorycondition; and increase the number of times the treatment sequence is tobe repeated based on the change in the person's respiratory condition.The combination respiratory therapy prescription creator may receivedata relating to a change in the person's respiratory condition andselect a different combination respiratory therapy device from thefamily of combination respiratory therapy devices based on the datarelating to the change in the person's respiratory condition.

The combination respiratory therapy prescription creator mayelectronically communicate the respiratory therapy prescription to amobile device configured for use by a respiratory therapist. Thecombination respiratory therapy prescription creator may electronicallycommunicate the respiratory therapy prescription to a device configuredfor use by the person. The combination respiratory therapy prescriptioncreator may present an interactive graphical depiction of therespiratory therapy prescription at the computing device. Theinteractive graphical depiction may include a 24-hour timeline and oneor more interactive slide bars to adjust the duration of portions of therespiratory therapy prescription along the timeline. The interactivegraphical depiction may include an animated simulation of at least aportion of the respiratory therapy prescription, and the animatedsimulation may include a graphical depiction of at least a portion ofhuman lungs receiving the simulated portion of the respiratory therapyprescription.

The combination respiratory therapy prescription creator mayelectronically communicate the respiratory therapy prescription to theselected combination respiratory therapy device for automated executionby the selected combination respiratory therapy device. The combinationrespiratory therapy prescription creator may receive the respiratorytherapy prescription from the computing device at a mobile deviceconfigured for use by a respiratory therapist and electronicallycommunicate the respiratory therapy prescription from the mobile deviceto the selected combination respiratory therapy device.

According to at least one aspect of this disclosure, a combinedrespiratory therapy device control module embodied in one or moremachine-accessible storage media is executable by a combinationrespiratory therapy device controller to monitor a period of time overwhich a person connected to a combination respiratory therapy devicecontrolled by the combination respiratory therapy device controller isto receive combined respiratory therapy according to a combinedrespiratory therapy prescription, where the combined respiratory therapyprescription defines a plurality of different therapy sessions to beperformed by the combination respiratory therapy device at differenttimes during the period of time, and each of the plurality of differenttherapy sessions comprising at least a mucus extraction therapy followedsubstantially immediately by a lung ventilation therapy or a lung volumerecruitment therapy; configure the combination respiratory therapydevice to perform each of the plurality of different therapy sessions atthe appropriate times and with the appropriate device settings accordingto the combined respiratory therapy prescription; and control thecombination respiratory therapy device to perform each of the pluralityof different therapy sessions at the appropriate times with theappropriate device settings according to the combined respiratorytherapy prescription.

The control module may repeat the mucus extraction therapy followedsubstantially immediately by the lung ventilation therapy or lung volumerecruitment therapy a predefined number of times during each treatmentsession. The control module may present an audio message to the personbefore performing the therapy sessions. The control module may presentthe audio message at a predetermined time in relation to the therapysessions. The control module may configure the audio message for theperson based on the person's age. The control module may configure theaudio message based on the time of day.

The control module may configure the combination respiratory therapydevice to supply positive-pressure air flow at a first pressure followedpositive-pressure air flow at a second pressure during the lungventilation or lung volume recruitment therapy, and configure thecombination therapy device to supply positive-pressure air flow at athird pressure greater than the first pressure followed bynegative-pressure air flow during the mucus extraction therapy. Thecontrol module may configure the combination respiratory therapy deviceto supply a series of air pulses prior to at least one of the therapysessions. The control module may receive user input, reconfigure thecombination respiratory therapy device based on the user input, andperform a modified therapy session based on the user input.

According to at least one aspect of this disclosure, a combinedrespiratory therapy system includes a combination respiratory therapydevice to execute a combined respiratory therapy prescription, where thecombined respiratory therapy prescription defines a plurality ofdifferent therapy sessions to be performed by the combinationrespiratory therapy device over a period of time, each of the pluralityof different therapy sessions includes at least a mucus extractiontherapy followed substantially immediately by a lung ventilation therapyor a lung volume recruitment therapy; a prescription creator moduleembodied in one or more machine-accessible storage media, theprescription creator module executable by a computing system to interactwith a physician to create the combined respiratory prescription; and acontrol module embodied in one or more machine-accessible storage media,the control module executable by the computing system to configure thecombination respiratory therapy device to perform the therapy sessionsaccording to the combined respiratory therapy prescription.

The system may include a data sharing module embodied in one or moremachine-accessible storage media, and the data sharing module mayelectronically communicate the combined respiratory therapy prescriptionto the combination respiratory therapy device. The data sharing modulemay electronically communicate the combined respiratory therapyprescription to another computing device. The data sharing module maydisplay at least a portion of the combined respiratory therapyprescription at another computing device used by healthcare personnel.The data sharing module may electronically communicate at least aportion of the combined respiratory therapy prescription from a remotecomputing device used by healthcare personnel to the combinationrespiratory therapy device. The data sharing module may display at leasta portion of the combined respiratory therapy prescription at anothercomputing device used by a person receiving the combined respiratorytherapy. The data sharing module may electronically communicate at leasta portion of the combined respiratory therapy prescription from acomputing device used by a person receiving the combined respiratorytherapy to the combination respiratory therapy device. The data sharingmodule may enable two-way electronic communication of at least a portionof the combined respiratory therapy prescription between or among aplurality of computing devices used by a plurality of healthcarepersonnel.

According to at least one aspect of this disclosure, a control unit fora combination respiratory therapy device includes an air supply; a firstair circuit operably coupled to the air supply to supplypositive-pressure air flow to a positive air flow patient interface ofthe combination respiratory therapy device; a second air circuitoperably coupled to the air supply to supply negative-pressure air flowto a negative air flow patient interface of the combination respiratorydevice; the second air circuit being physically separate from the firstair circuit; a controller to control the air supply; and memoryaccessible by the controller, the memory including instructionsexecutable by the controller to activate the air supply to supply air tothe first air circuit at a first positive pressure during a ventilationor lung volume recruitment portion of a respiratory therapy treatmentsession; and alternatingly activate the air supply to supply air to thefirst air circuit at a second positive pressure greater than the firstpositive pressure followed by a supply of air to the second air circuitat a negative pressure during a coughing assistance portion of therespiratory therapy treatment session.

The control unit may include another air supply and a third air circuitoperably coupled to the other air supply to supply a series of airpulses to an air pulse patient interface of the combination respiratorytherapy device. The third air circuit may be physically separate from atleast the second air circuit. The third air circuit may be physicallyseparate from the first air circuit and the second air circuit. The airpulse patient interface may be selectively coupled to the positive airflow patient interface. The control unit may include a control panel toinput patient condition information, where the control unit may beconfigured to adjust the operation of the air supply in real time basedon the patient condition information. The positive air flow patientinterface may supply positive air flow nasally and the negative air flowinterface may supply negative air flow orally. The control unit mayinclude one or more sensors in communication with the controller toalign the positive air flow with a person's normal breathing patternduring both the coughing assistance portion and the ventilation portionof the respiratory therapy treatment session.

A system for combination respiratory therapy may include any of theforegoing control units, the positive air flow patient interface, andthe negative air flow patient interface. The control unit may be inselective communication with an air pulse patient interface. Theinstructions may be configured to selectively provide, during therespiratory therapy treatment session: mucus extraction therapy followedby lung ventilation therapy; or mucus extraction therapy followed bylung volume recruitment therapy; or mucus mobilization therapy followedby mucus extraction therapy followed by lung ventilation therapy; ormucus mobilization therapy followed by mucus extraction therapy followedby lung volume recruitment therapy. The system may include a networkinterface to receive user input relating to a patient's condition fromanother device. The system may include a graphical user interface tocreate or modify the respiratory therapy prescription, and the graphicaluser interface may be located at the controller. The system may includean audio user interface to provide audio messages to a person using thecombination respiratory therapy device.

BRIEF DESCRIPTION OF THE DRAWINGS

This disclosure is illustrated by way of example and not by way oflimitation in the accompanying figures. The figures may, alone or incombination, illustrate one or more embodiments of the disclosure. Forsimplicity and clarity of illustration, elements illustrated in thefigures are not necessarily drawn to scale. For example, the dimensionsof some elements may be exaggerated relative to other elements forclarity. Further, where considered appropriate, reference labels may berepeated among the figures to indicate corresponding or analogouselements.

FIG. 1 is a simplified module diagram of at least one embodiment of acombination respiratory therapy management system;

FIG. 2 is a simplified flow diagram of at least one embodiment of amethod for configuring a combination respiratory therapy device;

FIG. 3 is a simplified schematic diagram for at least one embodiment ofa combination respiratory therapy management system;

FIG. 4 is a simplified elevational view of at least one embodiment of auser interface for a prescription creator module of at least oneembodiment of the system of FIG. 1;

FIG. 5 is a simplified elevational view of at least one embodiment ofanother user interface for a patient interface module of at least oneembodiment of the system of FIG. 1;

FIG. 6 is a simplified flow diagram of at least one embodiment of amethod for configuring respiratory therapy using the system of FIG. 1;

FIG. 7 is a simplified flow diagram of at least one embodiment ofanother method for configuring respiratory therapy using the system ofFIG. 1;

FIG. 8 is a simplified flow diagram of at least one embodiment ofanother method for configuring respiratory therapy using the system ofFIG. 1;

FIG. 9 is a simplified flow diagram of at least one embodiment ofanother method for configuring respiratory therapy using the system ofFIG. 1;

FIG. 10 is a simplified flow diagram of at least one embodiment of amethod for performing respiratory therapy using the system of FIGS. 1;and

FIG. 11 is a simplified block diagram of an exemplary computingenvironment in connection with which the system of FIG. 1 may beimplemented. FIG. 2 is

DETAILED DESCRIPTION

While the concepts of the present disclosure are susceptible to variousmodifications and alternative forms, specific embodiments thereof areshown by way of example in the drawings and are described in detailbelow. It should be understood, however, that there is no intent tolimit the concepts of the present disclosure to the particular formsdisclosed, but on the contrary, the intention is to cover allmodifications, equivalents, and alternatives consistent with the presentdisclosure and the appended claims.

Referring to FIG. 1, a system 100 for managing combined respiratorytherapy provided to a person using a combination respiratory therapydevice 110 includes a number of different pieces of computerizedfunctionality, which for ease of discussion are represented herein asmodules. Illustratively, these modules include a configurable userinterface module 114 and a combined respiratory therapy device controlmodule 120. In various embodiments of the system 100, the configurableuser interface module 114 may include one or more other modules 112,122, 130, 132, 134, 140, 142, 144. Each of the modules 114, 120, 112,122, 130, 132, 134, 140, 142, 144 may be implemented as computersoftware, firmware, hardware, or a combination thereof, according to therequirements of a particular design or implementation of the system 100.Further, any or all of the modules 114, 120, 112, 122, 130, 132, 134,140, 142, 144 may be implemented as part of the combination respiratorytherapy device 110 in some embodiments (e.g., as a “standalone” system),while in other embodiments, some of the modules 114, 120, 112, 122, 130,132, 134, 140, 142, 144 may be implemented on one or more othercomputing devices (e.g., mobile devices or more traditional desktop- orlaptop-style computers). As described in more detail below, theconfigurable user interface modules 112, 122, 130, 132, 134, 140, 142,144 can be selectively activated at the device 110 or at one or moreother computing devices to facilitate interaction with and control ofthe combination device 110 by an authorized person or by different typesof authorized persons. Such authorized persons may include clinicians(e.g., physicians), respiratory therapists, nurses, family members andother caregivers, as well as the patient receiving the combinedrespiratory therapy. For ease of discussion, any of such persons may bereferred to herein as a “user” or “users” of the system 100.

The prescription creator module 112 enables a user (e.g., a clinician)to create a combined respiratory therapy prescription in a user-friendlyway using, for example, graphical, audio, and/or video features. Assuch, the prescription creator module 112 alleviates the need for usersto spend time learning how to use non-intuitive buttons, dials, or thelike on a piece of therapy equipment that often has limited real estatefor more sophisticated user interface features. A combined respiratorytherapy prescription may include one or multiple integrated combinationsof different respiratory therapies that are scheduled to occur atvarious times of the day. For example, in some embodiments, a combinedrespiratory therapy prescription integrates repeated cycles of coughassistance (e.g., mucus mobilization and/or mucus extraction therapy)with lung ventilation therapy and/or lung volume recruitment therapy.The combined respiratory therapy prescription can be translated intomachine-readable instructions by the prescription translator module 122.Such instructions can be read and executed by hardware components (e.g.,a microprocessor) of the combination device 110 to control the provisionof combined respiratory therapy to the patient. Once created, thecombined respiratory therapy prescription and/or the machine-readableversion thereof may be stored in computer memory, for example, in acomputerized data structure such as a combined respiratory therapyprescription database 118.

The stored combined respiratory therapy prescription or portions thereofcan be accessed and viewed by the person who created the prescription orby other users (e.g., respiratory therapists, other clinicians,caregivers, or the patient) using the data sharing module 136. As such,the data sharing module 136 presents the combined respiratory therapyprescription in a format that is easy to understand and customizable byor for the particular user. In some embodiments, the data sharing module136 may allow certain categories of authorized persons to view certaindata or make certain types of changes to the combined respiratorytherapy prescription. For example, a clinician may be permitted to viewand change any aspect of the combined respiratory therapy prescription,while a therapist may be permitted to view the prescription but onlychange certain parts of the prescription (e.g., inspiratory orexpiratory pressure within a limited defined range of pressures, or thetherapy start time) but not others (e.g., the therapy duration).Similarly, limitations may be placed on a patient or family member'sability to view and change the combined respiratory therapyprescription.

In some embodiments, the user interface module 114 includes aproblem-first device control module 140, which allows a user to makeadjustments to the patient's therapy regimen while the therapy is inprogress, whether in response to a change in the patient's conditionobserved by the user, or in response to some other triggering condition.For example, in some embodiments, the prescription translator module 122may receive data from the combination device 110 while a therapy is inprogress, such as the current status of the therapy or information aboutthe patient's condition. Such data obtained from the device 110 can bedisplayed to the user in a human-understandable form using the datasharing module 136. Changes to the patient's therapy may be input by theuser in response to the data obtained from the combination device 110,or in response to changes in the patient's condition observed by thecaregiver, for example, using the problem-first device control module140.

Further, in some embodiments, the user interface module 114 includes anaudio interface module 142, and may also include a persona configurationmodule 144. The modules 142, 144 are designed to further enhance thehuman-device interaction. For example, the audio interface 142 may playpre-recorded human voice messages explaining how to use the device 110or explaining a therapy that is about to begin. The personaconfiguration module 144 may allow the user to ascribe a “personality”to the device 110. For example, the persona configuration module 144 mayallow the user to select a graphical or animated character and/or aparticular tone of voice or accent to be used by the device 110 whencommunicating with the user. Thus, using the system 100, a combinationrespiratory therapy device 110 can be used to provide multipleintegrated and coordinated respiratory therapies to a respiratorypatient over a period of time, in a manner that is both intuitive andnon-threatening to the user or the patient. Moreover, the varioustreatments specified by the respiratory therapy prescription can becustomized and adjusted, even down to the breath by breath level,according to the patient's needs as they might change or progress. Suchcustomizations and adjustments can be implemented responsively by thecombination respiratory device 110.

The illustrative combination respiratory therapy device 110 is one of afamily of combination respiratory therapy devices 110, each of which canbe used to provide multiple integrated respiratory therapies. Thecombination device 110 includes a combined respiratory therapy controlmodule 120, a positive-pressure air flow patient interface 124, anegative-pressure air flow patient interface 126, and, in someembodiments, an air pulse patient interface 128. The positive-pressureair flow patient interface 124 is designed to supply positive (e.g.,inspiratory) pressure to a patient with whom the interface 124 isengaged. The negative-pressure air flow patient interface 126 isdesigned to supply negative (e.g., expiratory) pressure to a patientwith whom the interface 126 is engaged. The air pulse patient interface128 is designed to supply air pulses to a patient's airway, lungs orchest area to provide, for example, Continuous High FrequencyOscillation (CHFO), Continuous Positive Expiratory Pressure (CPEP),and/or High Frequency Chest Wall Oscillation (HFCWO).

The illustrative control module 120 interfaces with the prescriptioncreator module 112 to obtain the user-defined and/or user-modifiedcombined respiratory therapy prescription. A version of the prescriptiontranslator module 122 may be provided at the user interface level (e.g.,as part of the configurable user interface module 114) and/or at thedevice level (e.g., as part of the control module 120) in variousembodiments of the system 100. Whether at the user interface level or atthe device level, the prescription translator module 122 converts theprescription into a machine-executable form that can be used to controlthe application of air flow to the patient via the interfaces 124, 126,128 as needed. For example, where a prescription specifies a treatmentsession to include a cough cycle followed by lung ventilation, theprescription translator module 122 generates the device settings neededfor the combination device 110 to perform the therapy session. Thosedevice settings may include, for instance, specific air pressure levels,an indication of whether the air pressure is to be positive (e.g.,inflation) or negative (e.g., suction), a duration of time to providethe airflow, a number of times to repeat the application of airpressure, etc. As an example, the device settings for a combinedrespiratory treatment sequence may include “cough: interface 124 on at+25 cm water, interface 126 on at −30 cm water; vent: interface 124 onat +15 cm water, interface 124 on at +4 cm water, time=2 minutes.” Thetranslator module 122 may further translate these device settings tospecific “valve open” and “valve close” control signals that can bereceived and acted on directly by specific electromechanical componentsof the device 110.

Using the combination respiratory therapy device 110, the lung volumerecruitment and lung ventilation therapies can be integrated withassisted cough cycles such that assisted ventilation or lung volumerecruitment can be automatically coordinated (e.g., alternated) withassisted coughing on a breath to breath basis if needed. In this way,the mix of cough assistance and lung ventilation or lung volumerecruitment therapy can be customized to each patient's needs. Further,the combination device 110 eliminates the need to apply two separatedevices sequentially. Sequential therapy is difficult for sick or weakpatients to tolerate and may cause the patient to become clinicallyunstable. Additionally, some embodiments of the combination device 110are portable, such that they can be mounted or stored on a wheelchair,thereby increasing the patient's quality of life. Still further, in someembodiments, the inspiratory and expiratory air circuits of the device110 are physically separated so that the positive pressure circuitremains clean and unobstructed. Further details of the illustrativecombination device 110 are described below in connection with FIG. 3.

In more detail, the illustrative prescription creator module 112utilizes a framework of standardized terminology to describe thecombined respiratory therapy prescription. As such, the frameworkprovides a vehicle by which combined respiratory therapy prescriptionscan be easily created, understood, and shared by the various healthcarepractitioners that may be involved in the patient's care. In thatregard, the illustrative combined respiratory therapy prescriptioncreator module 112 includes a layering module 130, a sequencing module132, and a patterning module 134. The layering module 130 allows thecaregiver to select an appropriate combination respiratory therapydevice 110 simply by specifying (at a graphical user interface of theconfigurable interface module 114, for example) the different types or“layers” of therapy that the patient needs.

The layering module 130 automatically maps the therapy layers selectedby the caregiver to one or more combination respiratory therapy devices110 that are capable of providing those therapies. In the illustratedembodiments, the therapy layers include mucus mobilization, mucusextraction, lung volume recruitment, and lung ventilation therapylayers. Generally speaking, mucus mobilization refers to respiratorytherapy that is intended to loosen chest secretions (e.g., mucus) sothat the chest secretions may be extracted from the lungs by a normal orassisted cough. Mucus mobilization therapy often involves the mechanicalapplication of air pulses, vibrations, or oscillations to the patient'sairway, lungs, chest and/or back by a device such as THE VEST, or theMETANEB device, both of which are available from the Hill-Rom Company,Inc.

Mucus extraction refers to therapy that mechanically assists thepatient's natural ability to cough, or which mechanically removessecretions from the lungs for the patient, if the patient is unable tocough on his or her own. To perform mucus extraction therapy, thecontrol module 120 may configure the combination device 110 to begin thetherapy by providing an extra-large expanded breath (e.g., “deep lunginsufflation”). This may involve the device 110 delivering aninspiratory pressure in the range of about 30%-50% above the “chronic”inspiratory pressure that the device 110 would normally use forventilation or lung volume recruitment therapy.

The deep breaths provided by the combination device 110 during mucusextraction therapy are intended to maximize lung recoil (faster flowduring exhalation) and may help expand any collapsed portions of thelung. But because they are big breaths, a patient can normally toleratemucus extraction therapy only in limited “doses.” During mucusextraction therapy, the control module 120 synchronizes the assistedinspiratory breath provided by the device 110 to the patient'sinspiratory effort, so that the patient does not exhale during theinspiratory phase. The “deep insufflation” breath is followed by“active” exhalation or “exsufflation,” during which suction (negative)pressure removes secretions from the airway. The control module 120likewise synchronizes the suction (negative) pressure to the patient'sexpiratory phase of breathing. Accordingly, some forms of mucusextraction therapy that can be provided by the device 110 may bereferred to as “mechanical insufflation/exsufflation.” For mucusextraction, the inspiratory pressure may be set in the range of about+25 cm water and the expiratory pressure in the range of about −30 cmwater, for example. Thus, a mucus extraction portion of the combinedrespiratory therapy prescription may be written as “+25/−30.”

Lung ventilation refers to therapy that is intended to mechanicallyassist the patient with his or her normal breathing pattern, or tomechanically breathe for the patient, if the patient is unable tobreathe on his or her own. Thus, lung ventilation therapy is generallyapplied in a continuous manner for a period of time (rather than in“cycles” like mucus extraction therapy). In the illustrated embodiments,in which they are integrated within a single combination respiratorytherapy device 110, both mucus extraction and lung ventilation therapyinclude software control algorithms that synchronize themachine-generated breathing or mucus extraction with the patient'snatural breathing pattern. Lung ventilation may be achieved by using thepositive-pressure air flow patient interface 124 to deliver a higherpositive pressure during the patient's inhalation and a lower positivepressure during exhalation. The difference between the inspiratory andexpiratory pressure levels (the “span”) is what ventilates the lungs.For lung ventilation, the inspiratory pressure may be set at +15 cmwater and the expiratory pressure at +4 cm water. Thus, a lungventilation portion of the combined respiratory therapy prescription maybe written as “+15/+4.”

To better achieve effective lung ventilation, the two positive pressurelevels can be synchronized to the patient's breathing pattern. To dothis, the combination respiratory therapy device 110 may detect a small,patient-generated negative “sniff pressure” or negative (inspiratory)flow to sense that the patient is starting inhalation (“wants a breath”)and then the device may support that breath with the commandedinspiratory pressure. When the device 110 detects that the patient'sinspiratory flow/pressure/effort tapers off, the device 110 can concludethat the patient is ready for exhalation and switch to the lower(expiratory) positive pressure setting (which may be known as the PEEPor positive end expiratory pressure).

In some embodiments, the control module 120 includes software thatsynchronizes the mechanically-assisted breathing provided by the device110 to the patient's spontaneous breathing. For example, in someembodiments, the control module 120 may keep track of the patient'srespiratory pattern over time, and use a prior respiratory pattern topredict a future respiratory pattern, in terms of rate of breathing,duration of inhalation, etc. In some embodiments, the flow waveform or“(chest) rise time” generated by the device 110 (how fast the device 110achieves the set inspiratory pressure) during lung ventilation therapymay be adjustable according to the patient's needs or preferences (aslower rise time is gentler, but too slow may leave the patientbreathless). The combination respiratory therapy device 110 may use thesame or similar techniques as described above to synchronize mucusextraction (assisted coughing) to the patient's breathing pattern, inorder to maximize the efficacy and comfort of mucus extraction therapyor for other reasons.

Additionally, when the combination device 110 is used for lungventilation, the control module 120 can instruct the device 110 toprovide a “backup” rate of breathing if the patient stops breathing ontheir own or is sedated, in which case the device 110 will deliverautomatic breathing on a timer. Further, when the device 110 is used forlung ventilation, the control module 120 can initiate an alarm to alertcaregivers if the interface 124 becomes disconnected from the patient(e.g., tubing is pulled away, nasal mask falls off, etc.). As such, thecombination device 110 can selectively provide a number of differentfeatures depending on the type of therapy for which it is being used,where some features (such as backup breathing and alarms) may beapplicable to some therapies but not others. The combination respiratorytherapy device 110 may use the same or similar techniques as describedabove to automatically provide mucus extraction (assisted coughing) to apatient who is asleep, unconscious or sedated; for example, by providingmucus extraction automatically, on a timer, while a patient is asleep.Likewise, the control module 120 can initiate an alarm to alertcaregivers if the negative airflow interface 126 becomes disconnectedfrom the patient (e.g., falls out of the patient's mouth).

Lung volume recruitment refers to therapy that mechanically inflates thelungs episodically rather than continuously. When the combination device110 applies positive pressure air flow for lung volume recruitment, thepositive pressure inflates the lungs, and thus prevents them fromcollapsing. This may be done, for example, after each cough cycle of adaytime therapy session, to help the patient recover his or her breathbefore the next cough. Lung volume recruitment therapy may also beapplied after an assisted cough therapy session has concluded, to“solidify” the lung volume improvements made during the assisted coughsession and to help the patient recover from the assisted coughing.Thus, lung volume recruitment therapy may be used when a patient isawake and cooperative.

As compared to lung ventilation therapy, lung volume recruitment isgenerally less sophisticated. When performing lung volume recruitmenttherapy, the combination device 110 may synchronize the inspiratorypressure to the patient's breathing pattern, but there may not be a needfor an expiratory pressure (PEEP). Since the patient is typically awakeand assisting with the process during lung volume recruitment therapy,more advanced software algorithms to track the patient's breathingpattern or to provide a backup rate or alarms are generally not needed,as they would be for lung ventilation. For lung volume recruitmenttherapy, the inspiratory pressure may be set in the range of about +15cm water and the expiratory pressure may be set in the range of about 0cm water (e.g., exhaling to no added pressure). Thus, a lung volumerecruitment portion of the combined respiratory therapy prescription maybe written as “+15/0.”

The sequencing module 132 allows the caregiver to define, customize, andmodify the details of each respiratory therapy treatment sessionaccording to the patient's needs, where a “treatment session” generallyrefers to an instance or occurrence of a coordinated combination ofrespiratory therapies. A treatment session may include a number ofsequentially-executed therapies, or treatment sequences that involve therepetition of one or more types of therapy (such as a treatment sequencemade up of cough assistance followed by lung ventilation therapy). Forexample, the sequencing module 132 may be used to define or specify thepositive and negative pressure settings that comprise each cough cycle;to define or specify the number of cough cycles that will be appliedsequentially at the start of each treatment sequence; to define orspecify the duration of lung volume recruitment or lung ventilationtherapy to be applied substantially immediately after the specifiednumber of cough cycles (e.g., without interruption) to complete eachtreatment sequence; and/or to define or specify the number of treatmentsequences that, applied sequentially, may comprise a treatment session.

The patterning module 134 allows the caregiver to define an entirepattern of respiratory care to be applied to the patient over a definedperiod of time (e.g., a 24-hour period), in real clock time. Forexample, a therapy pattern may include a treatment session comprised ofa specific number of treatment sequences, as described above, whichstarts and ends in the morning; a similar treatment session that startsand ends in the evening, but is immediately preceded by a time period ofmucus mobilization therapy; and a lung ventilation therapy session thatstarts at night, when the patient falls asleep, and ends in the morning,when the patient awakens. As such, the patterning module 134 allows thecaregiver to specify that the combination device 110 begins or performscertain therapies at certain times of the day. In other words, thepatterning module 134 can be used to associate specific start and stoptimes with the various coordinated therapies. The patterning module 134can be used to illustrate a patient's specific layers of therapy andtheir inter-relationships in clock time. As such, the patterning module134 can provide a useful tool for creating, modifying and sharing thecombination respiratory therapy prescription among interested parties.Thus, in some embodiments, the patterning module 134 presents thepattern of respiratory therapy visually, e.g., as a graphical timelineor other visual representation of the patient's 24-hour respiratory careplan, at a user interface of the system 100. An illustrative example ofone such visual representation is shown in FIG. 4, described below.

The configurable user interface module 114 includes a software-baseduser interface to the various modules 112, 122, 136, 140, 142, 144. Forexample, in embodiments that include the prescription creator module112, the user interface module 114 includes a software-based userinterface that allows a physician or other qualified health professionalto create the combined respiratory therapy prescription and store theprescription (e.g., in the database 118) at a computing device of thesystem 100. In other embodiments, the user interface may alternativelyor in addition, provide the user with access to the data sharing module136, the problem-first device control module 140, and/or other modulesof the system 100.

As noted above, the data sharing module 136 provides a communicationinterface by which a combined respiratory therapy prescription, orportions thereof, can be presented at a computing device of the system100 used to create the combined respiratory therapy prescription to thecombination device 110, or at another computing device, such as a mobiledevice used by a respiratory therapist responsible for the patient'scare, or a computing device located near the patient or used by thepatient (such as a personal computer or mobile computing device locatedin the patient's hospital room or in the patient's home). In someembodiments, the prescription is shared between or among devices usingan electronic communication interface accessed by the data sharingmodule 136, which includes, for example, one or more input/outputmodules for data communication via a standard wired or wireless networkinterface (e.g., WIFI, cellular, Ethernet, etc.), one or more hard-wiredcommunication ports (e.g., a Universal Standard Bus port or other portby which a flash drive or cable may be connected), or a combinationthereof.

Whereas the prescription creation module 112 allows the combinedrespiratory therapy prescriptions to be created using a “user-friendly”interface and then transferred to the combination device 110 forexecution, the illustrative data sharing module 136 enables specializedrespiratory clinicians who are not at the patient's bedside to remotelychange or update the patient's respiratory prescription, in order torespond in a timely manner to clinical changes in the patient'scondition or for other reasons.

One illustrative example of a scenario in which the data sharing module136 may be used is as follows. Using a computer on which theconfigurable user interface module 114 is configured to include theprescription creator module 112, e.g., the prescription creator module112 is either installed or accessible via a network (e.g., the “cloud”),such as a hospital computer used to manage electronic medical records, aphysician creates a combined respiratory therapy prescription. Thelayering module 130 automatically selects a combination device 110 to beused to implement the prescription. The patterning module 134 displaysthe chronological pattern of prescribed therapy in clock time. Thesequencing module 132 generates the specific details of the treatmentsequences that form the treatment sessions, including all of therequisite device settings for the selected combination device 110. As aresult, the physician can, via the configurable user interface module114, examine and adjust or modify the patient's combined respiratoryprescription quickly and accurately, using, e.g., the hospital computer.Another version of the configurable user interface module 114, includingthe data sharing module 136, may be installed on another computer usedby the physician, to allow the physician to view the combinedrespiratory prescriptions that he or she has created from a remotelocation, even from home.

Yet another version of the configurable user interface module 114,including the data sharing module 136, may be installed on a computerused by a respiratory therapist. With the data sharing module 136, therespiratory therapist reviews the combined respiratory therapyprescription (e.g., at a hospital computer) previously created by thephysician. The computer may be a handheld device or the therapist maytransfer the prescription to another computing device that is a handheldor “mobile” device (such as a smart phone, tablet computer, or personaldigital assistant) on which another instance of the configurableinterface module 114 or a simplified version thereof including the datasharing module 136 is installed.

Using the data sharing module 136, which may be installed directly onthe handheld computing device or accessed via a network (e.g., the“cloud”), the therapist is able to plan his or her shift schedule byviewing the 24-hour prescription timelines (e.g., treatment patterns),and/or other details of the combined respiratory therapy prescriptions,for all of the patients under his or her care. Using the handhelddevice, the therapist can review the treatment plans at any time,whether the therapist is at the patient's bedside or at a distantlocation. With the data sharing module 136, the therapist's handhelddevice can be programmed to issue reminders that can help keep thetherapist on schedule by generating an audio and/or visual alert at orin advance of the start time for the patient's next scheduled therapy.Also using the data sharing module 136, the therapist's handheld devicemay link to an electronic communication network (e.g., a hospital pagingsystem, computer network, or telecommunications network), to alert thetherapist when new combined respiratory therapy prescriptions arecreated or existing prescriptions are modified by other caregivers, forexample. Further, using the data sharing module 136, new or updatedcombined respiratory therapy prescriptions can be transferredelectronically (e.g., via a direct, hard-wired connection or over awired or wireless network) to the therapist's handheld device (whereverit may be located) in real time or downloaded to the handheld devicefrom, e.g., a hospital computer. When the therapist signs out from ashift, he or she can transfer the combined respiratory therapyprescriptions for the patients in his or her care to a handheld deviceused by the next therapist that is coming on duty, by linking thehandheld devices using a wired or wireless (e.g., WIFI or Near FieldCommunication (NFC)) data communication connection.

When a patient is ready to change venues, e.g., to move to a differenthospital or nursing home, or to return to the patient's own home, thedata sharing module 136 can be used to send the patient's combinedrespiratory therapy prescription to the patient's new venue via wired orwireless data communication as described above. As the combinedrespiratory therapy prescription specifies the combination device 110 tobe used to perform the combined respiratory therapy prescription, aswell as the particular schedule and combination of respiratory therapiesto be performed for the patient (including the device settings), thetransfer of the prescription to a computing device located at thepatient's new venue should enable the patient's respiratory care to becontinued at the new location relatively seamlessly.

The illustrative problem-first device control module 140 interfaces withthe prescription translation module 122 to directly implement changes toa patient's combined respiratory therapy prescription “on the fly,”e.g., in real-time during the patient's therapy, according to thepatient's preferences or as the patient's health condition changes. Theproblem-first device control module 140 includes computer logic and data(e.g., look-up tables or the like) that map various device settings ofthe combination device 110 to different clinical conditions. Forexample, the problem-first module 140 may derive triggering conditionsand desired therapeutic changes from evidence-based guidelines or fromthe patient's own treatment history data (which may indicate therapiesthat have been successful or unsuccessful for the patient in the past).As such, the problem-first module 140 allows caregivers and others tomodify the patient's combined respiratory therapy prescription simply byindicating the clinical change to the problem-first module 140. Forexample, a therapist may notice that his or her patient is currentlyunable to cough up secretions without assistance. In this scenario, thecaregiver can input “unable to cough up secretions” to the problem-firstmodule 140, using a graphical user interface provided by theconfigurable user interface module 114, for example. The prescriptiontranslation module 122 translates the clinical change into theappropriate device setting changes for the combination device 110. Inembodiments where the problem-first module 140 is not integrated withthe combination device 110, the data sharing module 136 transfers thedevice setting changes directly to the combination device 110, whichimplements the device setting changes. In other words, the problem-firstdevice control module 140 enables direct, automatic prescriptionrevision, without requiring the user to view or compose an entireprescription.

The illustrative problem-first device control module 140 can also allowthe user to respond to data transmitted by the combination device 110,via the data sharing module 136. Based on changes in the data receivedfrom the combination device 110, which the caregiver may view using thedata sharing module 136, for example, the caregiver may determine thatadjustments to the patient's combined respiratory therapy prescriptionare needed, and implement those adjustments using the problem-firstdevice control module 140 as described above.

One illustrative example of a scenario in which the problem-first devicecontrol module 140 may be used is as follows. Suppose a home carecompany receives a new patient who had been discharged from thehospital. Using the data sharing module 136, the patient's combinedrespiratory therapy prescription has been electronically sent to thehome care company's computer. As a result, the company knows whichcombination device 110 it needs to provide for the patient and alsoknows the patient's specific respiratory therapy treatment plan.

Using the data sharing module 136 as implemented on his or her handhelddevice, a home care therapist employed by the home care companydownloads the patient's combined respiratory therapy prescription to hisor her handheld device and brings it to the patient's home. Thetherapist may then use the data sharing module 136 to transfer thepatient's combined respiratory therapy prescription directly to thecontrol module 120 of the combination device 110 (e.g., by connectinghis or her handheld device to the combination device 110). If aprescription translation module 122 is installed on the therapist'shandheld device, the prescription may be translated to machine-readableinstructions at the hand held device and then implemented directly bythe combination device 110. Alternatively, the prescription may betranslated by the prescription translation module 122 of the controlmodule 120.

During or after a therapy session, the combination device 110 can senddata about the therapy session or data relating to the patient'scondition or preferences to the clinician's handheld device (e.g., inthe form of a notification message). Based on this notification and,perhaps, a telephone follow-up with the patient, the clinician can usethe problem-first module 140 to change the patient's combinedrespiratory prescription and send the new prescription to the device 110using the data sharing module 136. Using the data sharing module 136,the new or changed prescription can be made available at a display ofthe device 110 or at other electronic devices, for viewing by the homecare company, other caregivers, the patient, and/or family members ofthe patient, for example.

The audio interface module 142 includes a software-based user interfaceto the prescription creator module 112, which allows the patient and/orfamily members or others associated with the patient to view thepatient's combined respiratory therapy prescription and configurereminders, alerts, and other messages relating to the patient's therapyprescription. In some embodiments, the audio interface module 142provides a software-driven, human-voice natural language interface tothe combination device 110. The audio interface 142 maps pre-recordedhuman voice messages (or computer-synthesized spoken natural languagemessages) to various aspects of the patient's combined respiratorytherapy prescription, as may be desired by the patient or configured bya caregiver or family member. For example, the recorded messages mayprovide instructions on how to use the combination device 110 or adjustits settings. These instructional-type messages may be timed to beplayed prior to the start of a therapy session or upon the user'srequest. For example, the patient may input a coded question such as“how do I turn this device on?” and in response, the audio interface 142may provide the requested instructions.

In some embodiments, the audio interface 142 may be programmed to playrecorded messages of an inspirational or reassuring nature atappropriate times, prior to, during, or after a therapy session. In somecases, the content and timing of these types of messages is based on thepatient's preferences, focus groups, and/or research relating to thepsychology of people who have chronic illnesses. For example, patientswith chronic illnesses may have psychological profiles that could impairtheir compliance with the use of respiratory therapy devices and othermedical devices, such as chronic anxiety or social or behavioraldisorders. Additionally, pediatric patients can be especially fearful ofmechanical devices. Thus, the use of respiratory care devices and othermedical devices can be viewed as a burden rather than a benefit by manypatients, resulting in poor compliance and limited device efficacy. Theaudio interface 142 is therefore designed to implement the concept ofanthropomorphism (the attribution of human characteristics to non-livingthings) to improve patient compliance with his or her combinedrespiratory therapy prescription by making the device 110 more appealingand enjoyable to use.

The audio interface 142 also allows the patient or other user to choose(e.g., from a list of choices presented on a touchscreen display of theconfigurable user interface module 114) the timing of the desiredmessages. For example, the patient may specify that a message is to beplayed in the morning, on the patient's awakening, before the start of atreatment session, during a treatment session, after a treatmentsession, and/or at bedtime. In other words, a particular recordedmessage may be linked to one or more portions of the patient's combinedrespiratory therapy prescription (e.g., treatment sessions and/ortreatment sequences) over the course of a treatment pattern (e.g., a24-hour timeline).

In the illustrative embodiments, the audio interface module 142interfaces with a persona configuration module 144, which allows thepatient to select an identity or personality to be ascribed to thecombination device 110. An example of a user interface that may beimplemented by the configurable user interface module 114 in connectionwith the persona configuration module 144 is shown in FIG. 5. In FIG. 5,an illustrative display screen 500 includes a number of selectablechoices 510, each of which embodies a different persona or “mascot” thatmay be ascribed to the combination device 110. The selection of a choice510 automatically configures the character of the voice (e.g., pace,tone) and the content of the pre-recorded audio messages to correspondto the selected persona/mascot. In some embodiments, a graphical oranimated depiction of the selected character may be displayed to theuser, as well.

The illustrative display screen 500 is a touch-sensitive screen suchthat selection of a choice 510 can be accomplished by the patient oranother user simply touching the desired choice on the screen with ahand, finger, stylus, or the like. Once a choice 510 is selected, thepersona configuration module 144 configures the content, timing, voice,and intonation of the pre-recorded audio messages to correspond to theselected persona. To do so, the persona configuration module 144 mayselect and download recorded messages from a pre-recorded messagedatabase that are tagged or otherwise associated with the selectedpersona. For example, the pre-recorded message database may associatethe characteristics of “reliable,” “tenacious,” and “determined” withthe “Winston the Bulldog” persona, and so on. In this way, thecombination device 110 can be customized to project a set of humancharacteristics that appeal to the patient, so that the patient mayperceive the device 110 as an ally and companion rather than as aninanimate object that is a threat or a burden, and thereby facilitateinteractions between the patient and the combination device 110.

One illustrative example of how the audio interface module 142 and thepersona configuration module 144 can be used to customize the messageoutput provided by the combination device 110 is as follows. Suppose apatient would like her combination device 110 to exhibit the humanqualities of tenacity and reliability. The patient can use thetouchscreen display to input these desired characteristics to the audiointerface module 142 (by, for example, selecting them from a drop-downlist). The persona configuration module 144 maps the patient's choicesto one or more pre-defined personas, which it displays in the list ofselectable choices 510 on the display screen 500. From the list ofchoices 510, the patient selects choice D, “power girl.” As a result,the audio interface 142 plays a reassuring message each night, justbefore the combination device 110 begins a therapy session to assist thepatient's breathing during sleep, such as, “I will help you breathecomfortably all night. If you need a cough, just let me know by pressingyour thumb switch. I won't let you down. See you in the morning!”

In some embodiments, aspects of the audio interface 142 are adapted foruse by clinicians, therapists, or other users, alternatively or inaddition to its use in connection with the patient. For example, theaudio interface 142 may be configured to output instructions forpreparing a combined respiratory therapy prescription or instructionsfor using the combination device 110, in a spoken natural language form,to a caregiver. As another example, the audio interface 142 may beconfigured as an interface to the problem-first module 140 of the devicecontrol module 140, described above.

Referring now to FIG. 2, an illustrative method 200 executable ascomputerized programs, routines, logic and/or instructions by thecombined respiratory therapy prescription creator module 112 and/or oneor more of the other modules of the system 100 to create a combinedrespiratory therapy prescription for a patient is shown. The method 200may be viewed as one example of how the combined respiratoryprescription creator module 112 could work. In that case, the primaryuser would likely be a physician using the method 200 to create aprescription for one of his or her patients. At block 210, the method200 receives information about a patient's respiratory condition. Suchinformation may include a symptom or a recent change in the patient'sclinical condition, which may be input by a clinician, such as aphysician, or by a caregiver, or even by the patient or a family member,for example (using, e.g., the problem-first device control module 140).At block 212, the method 200 determines which of the therapeutic layers(e.g., mucus mobilization 214, mucus extraction 216, lung volumerecruitment 218, lung ventilation 220) are associated with theinformation about the patient's condition received at block 210. Forexample, if the input at block 210 indicates that the patient is havingtrouble generating a productive cough on his or her own, the method 200maps that information to one or more of the therapy layers 214, 216,218, 220 that are directed to providing cough assistance. In this case,those therapy layers include the mucus extraction and either lungventilation or lung volume recruitment therapy layers. Alternatively,the method 200 may receive information about the patient's respiratorycondition, as mentioned above, from the clinician creating the combinedrespiratory therapy prescription, and the clinician may select anddetermine the therapeutic layers by himself or herself (e.g., manually),using, for example, the combined respiratory therapy prescriptioncreator module 112.

The determination of whether to select lung ventilation 220 or lungvolume recruitment 218 can be based on additional inputs received at oneor more of the modules 114, 120, or stored information about thepatient's current health condition or clinical history. For example, atblock 212, the method 200 may access electronic medical recordsassociated with the patient and thereby determine that the patient hasresponded well in the past to lung ventilation therapy provided aftermucus extraction therapy. As another example, the method 200 may accessdate and time information that is automatically kept by the system 100,determine therefrom that the patient is likely to be awake and able toparticipate at the time of the therapy session, and select the lungvolume recruitment therapy layer 218, rather than the lung ventilationtherapy layer 220, as a result.

Once the therapy layers associated with the patient's condition havebeen determined, at block 222, the method 200 automatically selects anappropriate combination device 110 from the family of combinationrespiratory therapy devices, based on the therapy layers determined atblock 212. Illustratively, the family of combination devices includesfour combination devices 224, 226, 228, 230. The mapping of therapylayers 214, 216, 218, 220 that can be provided by each of the devices224, 226, 228, 230 is shown illustratively by lines connecting thevarious therapies with the corresponding combination devices, in block222. For example, the combination device 224 can be used to provide bothmucus extraction and lung ventilation therapies. The combination device226 can provide both mucus extraction and lung volume recruitment. Thecombination device 228 can provide all three of mucus mobilization,mucus extraction, and lung ventilation therapies. The combination device230 can provide all three of mucus mobilization, mucus extraction, andlung volume recruitment therapies. The method 200 determines which ofthe combination devices 224, 226, 228, 230 to select based on eachdevice's capabilities in relation to the therapy layers 214, 216, 218,220 determined at block 212 to be needed by the patient. For example, ifthe patient needs mucus mobilization, the method 200 may select eitherdevice 228 or device 230, but not device 224 or device 226. If thepatient needs cough assistance therapy but can otherwise breath on hisor her own, the method 200 may select device 226 or device 230, but notdevice 224 or device 228.

Once a combination device has been selected, at block 232, the method200 obtains the information it needs from the user to prepare a combinedrespiratory therapy prescription for the patient using the combinationdevice 110 selected at block 222. To do this, the method 200 interfaceswith the user to define one or more treatment sessions 234, define oneor more treatment sequences 236 for each treatment session, and definethe treatment patterning 238 over a period of time during which thepatient is to receive respiratory care. In the illustrated examples, atreatment session is made up of a number of treatment sequences that areapplied consecutively, e.g., repeated successively a defined number oftimes, where each treatment sequence includes one or more assisted coughcycles followed substantially immediately by lung ventilation or lungvolume recruitment therapy. Thus, the duration of a treatment sessioncan depend on the number of treatment sequences to be provided duringthe treatment session. So, the process of defining the treatment sessionor sessions 234 involves the method 200 interfacing with the user tospecify, over the respiratory care period or “pattern,” the number oftreatment sessions to be performed, the start time for each treatmentsession, and the number of treatment sequences to be performed in eachtreatment session.

Next, the method 200 interfaces with the user to define the details ofeach of the treatment sequences 236 to be performed in each of thetreatment sessions defined at block 234. To do this, the method 200interfaces with the user to specify the number of assisted cough cyclesin each treatment sequence, the inspiratory and expiratory pressures foreach cough cycle (e.g., +25 cm water inspiratory pressure, −30 cm waterexpiratory pressure), the amount (duration of time) of assistedventilation to follow the cough cycles (e.g., 2 minutes), and theinspiratory and expiratory pressures for the assisted ventilationtherapy (e.g., +15 cm water inspiratory pressure, +4 cm water expiratorypressure).

At block 238, the method 200 may interface with the user to defineadditional respiratory therapies that may be applied to the patientduring the respiratory care period or pattern (e.g., a 24-hour period).For example, the caregiver may wish to schedule one or more mucusmobilization therapies to occur prior to a treatment session, or add anadditional daytime or night-time lung ventilation or lung volumerecruitment therapy. Accordingly, at block 238, the method 200interfaces with the user to specify the start times, stop times, anddevice settings for each of the additional desired therapies.Additionally, at block 232, the method 200 may interface with the userto receive other details relating to the combined respiratory therapyprescription. For example, the user may wish to specify that certainportions of the patient's prescription can be modified by the patient ora family member, while other portions can only be modified by the useror an authorized physician, or that some portions can be modified by thepatient or family member with the user or physician's authorization.Once the combined respiratory therapy prescription is complete (to thesatisfaction of the user), the method 200 electronically communicatesthe combined respiratory therapy prescription to the combination device110 for execution by the device 110. As noted above, this can be doneusing a wired or wireless data communication method.

One illustrative example of a user interface 400 that may be provided inconnection with the process of creating a combined respiratory therapyprescription using the system 100 is shown in FIG. 4. The user interface400 displays a timeline 410, a legend 412 describing the keyabbreviations used in the timeline 410, various details of therespiratory care pattern in their sequential order of occurrence alongthe timeline 410 (described below), and a simulation feature 440 whichallows the user to see an animated simulation 442 (e.g., an animatedgraphic or video clip) of respiratory therapy as it would be applied tothe patient's lungs. To view a simulation, the user may select orhighlight one of the therapies or treatment sessions displayed on thetimeline 410 and then select the view simulation button. The system 100then locates and accesses a stored simulation that corresponds to theselected therapy or treatment session (where, for example, suchsimulations may be indexed or tagged according to their associatedtherapies or treatment sessions and stored in a database).

The illustrative timeline 410 includes two treatment sessions, TS-1 andTS-2, as well as a mucus mobilization therapy session M-2 and anight-time nasal lung ventilation therapy session NIV. Each of thesesessions has an associated start time. For example, the treatmentsession TS-1 has a start time of 8:00 a.m., the mucus mobilizationtherapy session has a start time of 7:50 p.m., the treatment sessionTS-2 has a start time of 8:00 p.m., and the night-time nasal lungventilation therapy session has a start time of 10:00 pm. The start timeand/or end time and duration of each of these sessions can be variedusing selectable markers 418, 420, 430, 432, 434, 436, 438. For example,the caregiver may select or “click” on a marker and drag or slide ithorizontally to the right or left to change the patient's therapypattern or schedule. Moving a start-time marker (e.g., markers 418, 438,430, 434) to the left causes the therapy to have an earlier start time,while moving the start-time marker to the right will cause the therapyto start later in the day. Moving an end-time marker (e.g., markers 420,430, 432, 436) to the left will decrease the duration of the therapy,while moving the end-time marker to the right will increase the therapyduration. In the illustrated example, the marker 430 is both astart-time marker (for the treatment session TS-2) and an end-timemarker (for the mucus mobilization therapy MM). This indicates to thesystem 100 that the treatment session TS-2 is to begin substantiallyimmediately upon the completion of the mucus mobilization session MM. Inthis way, dependencies between the various therapies can be created sothat their performance can be coordinated automatically.

Each of the therapy sessions (TS-1, MM, TS-2, NIV) can have anexpand/contract button (e.g., 422, 426, 428) associated with it. Theexpand/contract buttons 422, 426, 428 can be selected to show or hidefurther details about the therapy session, such as the number oftreatment sequences, the device settings, etc.). In the illustratedexample, the expand/contract button 422 has been selected to showfurther details of the treatment session TS-1. Those details aredisplayed in a window 414. The window 414 shows that the treatmentsession TS-1 is made up of 5 treatment sequences. Each of the treatmentsequences (SEQ 1, SEQ 2, SEQ 3, SEQ 4, SEQ 5) has its own start and endmarkers 444, 448, 450, 452, 454, 456, which the user can slide back andforth horizontally to adjust the duration of the treatment sequence(e.g., to adjust the number of cough cycles in the treatment sequence orthe duration of the lung ventilation). The markers 448, 450, 452, 454act as both start and end markers, thereby making the start time for thebeginning of the next treatment sequence (e.g., SEQ 2) dependent on thecompletion of the previous treatment sequence (e.g., SEQ 1) rather thanon a specific clock time. Each of the treatment sequences also has anexpand/contract button 424, 458, 460, 462, 464 associated with it. Assuch, the caregiver can view and/or modify the details of a particulartreatment sequence by selecting the corresponding expand/contract button424, 458, 460, 462, 464. In the illustrated example, the button 424 hasbeen selected to show the details for the treatment sequence SEQ 1. Asshown in the window 416, these details include four assisted coughcycles with +25 inspiratory pressure/−30 expiratory pressure followed bytwo minutes of lung ventilation at +15 inspiratory pressure/+4expiratory pressure. The details shown in the windows 414, 416 can behidden by selecting the corresponding expand/contract button (e.g., 422,424) again. Similarly, the simulation 442 can be hidden by selecting thebutton 440 a second time. In some embodiments, the window 416 isinteractive (e.g., it contains one or more text boxes) so that thedetails shown therein can be edited directly by the caregiver.

Referring now to FIG. 3, an illustrative control unit 300 for thecombination device 110 is shown in greater detail. The control unit 300is embodied as a housing (e.g., plastic or metal), which contains orsupports, as the case may be, the electronic and mechanical componentsshown inside the dashed lines in FIG. 3. In some embodiments, thehousing is sized and designed so that the control unit 300 is relativelylightweight and portable. For example, some embodiments of the controlunit 300 are configured so that they may be mounted to a patient supportapparatus, such as a wheelchair, stretcher, lift, hospital bed, or otherpatient transport device.

The housing has defined therein a number of ports to which a number ofpatient interfaces 322, 324, 326 can connect to provide various forms ofrespiratory therapy to the patient. The positive airflow patientinterface 322 is one exemplary embodiment of the positive-pressureairflow patient interface 124 shown in FIG. 1. The patient interface 322is embodied as a nasally mounted device that contains a pair of airdelivery conduits, each of which is configured to engage one of thepatient's nostrils. As such, the patient interface 322 is configured tosupply positive-pressure airflow to the patient via the patient's nose.

The patient interface 324 is one exemplary embodiment of the negativeairflow patient interface 126 of FIG. 1. The patient interface 324 isembodied as mask that is designed to engage with the patient's moutharea to supply airflow through the patient's mouth. In the embodiment ofFIG. 3, the patient interface 322 is configured to supply only positiveairflow and the patient interface 324 is configured to supply onlynegative-pressure airflow to the patient. In other words, theillustrative patient interface 324 is only used for thenegative-pressure portions of assisted cough cycles, and is not used toprovide lung ventilation or lung volume recruitment therapy. Similarly,the patient interface 322 is only used for lung ventilation, lung volumerecruitment, and the inspiratory pressure portion of assisted coughcycles, and is not used during the negative-pressure portions of theassisted cough cycles. This configuration of the interfaces 322, 324keeps the positive and negative air flow circuits separate, and thusfree of contamination. In other embodiments, however, the interfaces322, 324 may be combined or integrated as a single patient interface;for example, as a single patient interface having separate positive andnegative airflow circuits.

The air pulse patient interface 326 is one exemplary embodiment of thepatient interface 128 shown in FIG. 1. In some embodiments, theinterface 326 is embodied as a wearable element to which tubing can beconnected to supply air pulses to the patient's chest region when worn.One example of such a device is THE VEST, available from the Hill-RomCompany, Inc. Alternatively or in addition, some embodiments may providecertain forms of air pulse therapy using the negative airflow patientinterface 324. For example, a METANEB device or other type of continuoushigh frequency oscillation (CHFO) device 364 may be connected to thenegative airflow patient interface 324. Other devices that providevarious forms of air pulse therapy may also be used in a similarfashion.

In the embodiment of FIG. 3, all of the computer programs and othercomponents that provide the functionality of the system 100 reside inthe control unit 300. That is, all of the various features of the system100 provided by the various modules described above can be accessed andused directly at the control unit 300. Accordingly, the illustrativecontrol unit 300 includes therein a controller 310, which may beembodied as one or more microprocessors, microcontrollers, digitalsignal processors, or the like. The controller 310 communicateselectronically with many other elements of the control unit 300 via adata communication link or bus 316 (e.g., a Controller Area Network busor the like). In some embodiments, the control module 120, theconfigurable user interface module 114, the prescription database 118,and/or any of their respective submodules, described above, are embodiedas software that is stored in e.g., disk storage, and then loaded intomemory 312 (e.g., random-access memory (RAM)) at runtime as needed. Insome embodiments, portions of the data 118 and/or the modules 114, 120may be embodied as firmware residing in non-volatile memory. Further, insome embodiments, the memory 312 may be integrated with the controller310. Accordingly, the simplified illustration of FIG. 3 showing theconfigurable user interface module 114, the prescription database 118,and the control module 120 embodied in the memory 312, which isaccessible to the controller 310, is intended to cover all of thevarious possible embodiments of the database 118 and modules 114, 120,whether implemented as software, firmware, hardware or a combinationthereof.

The control unit 300 includes a control panel 318, which, as indicatedby the schematic of FIG. 3, may have its own power supply. Theillustrative control panel 318 includes a display screen 320, which maybe embodied as a touchscreen display supported by the housing of thecontrol unit 300. During operation, information about the combinationdevice 110, such as the current device settings, as well as therapybeing performed, may be displayed on the display screen 320. Featuresprovided by the modules 114, 120, and/or data accessed from the database118, may be made available through the control panel 318 and/or thedisplay screen 320, or may be provided at other computing devices asdescribed above. In other words, any of the features of the system 100described above may be accessible to users via the control panel 318and/or the display screen 320, or through other computing devices asdescribed herein, in various embodiments of the system 100.

The control unit 300 includes an audio circuit illustratively made up ofan audio interface 372, an audio driver 374, an amplifier 376 and anaudio controller 378. The audio circuit is configured to allow thesystem 100 to process audio inputs and output audio through speakers asauditory sound, in order to implement the features of the audiointerface 142 described above. While the embodiment of FIG. 3 shows theaudio circuit as being part of the control unit 300, it should beunderstood that portions of the audio interface 142 may be implementedat a computing device (such as a user's local computing device) usingsimilar components. As such, the patient or another user may interactwith the combination device 110 either via the control panel 318 or viaanother computing device, in various embodiments of the system 100.

The control unit 300 includes a data management module 382, a networkconnector 384, and a power management module 386. The data managementmodule 382 manages the communication of data (e.g., portions of thepatient's combined respiratory prescription, data generated by thedevice 110 during operation, etc.) from the device 110 to other devicesand vice versa, using the network connector 384. The power managementmodule 382 interfaces with a power supply (e.g., a battery or a wallsocket) to supply electrical power to the various components of thecontrol unit 300. The network connector 384 may include a wirelessnetwork interface, Ethernet adapter, and/or other components as may beneeded or desired to enable the control unit 300 to electronicallycommunicate with other devices through either a wired or wirelessnetwork connection.

A finger switch 380 is also provided at the control unit 300 and is inelectronic communication with the controller 310. Portions of the fingerswitch (e.g., a lever, dial, button or toggle) are mounted to thehousing of the control unit 300 to be easily accessible to the patient.The controller 310 is configured to turn the execution of the patient'scombined respiratory therapy prescription on or off in response tosignals received from the finger switch 380. For instance, in someembodiments, the controller 310 is responsive to the finger switch 380to activate or deactivate an assisted cough therapy. That is, if thepatient feels congested and needs to cough, the patient may activate thefinger switch to initiate an assisted cough therapy. Similarly, if atherapy is in progress and the patient becomes uncomfortable, thepatient may press the finger switch to discontinue or temporarily stopthe therapy.

The remaining components of the control unit 300 shown in FIG. 3 includemechanical and electromechanical components to effectuate the variousaspects of the patient's combined respiratory therapy prescriptionthrough the patient interface(s) 322, 324, 326. In operation, thecontroller 310 executes the combined respiratory therapy prescription bysending control signals to the various components at the appropriatetimes, via the bus 316 and a number of servo control modules 350, 354,356, 358, 368. The servo control modules 350, 358 operate controlcircuits to control motors 386, 360, respectively, which operatemanifolds 332, 330, respectively, to control the flow of air generatedby an air supply 328 (e.g., a blower) to the patient interfaces 322,324, 326. The servo control module 354 operates a control circuit tocontrol the generation of air pulses by the air pulse generator 352based on airflow received from the air supply 328 through the manifolds330, 332 and the valve 348. The servo control module 356 controls theoperation of the air supply 328 based on parameters supplied by thecontroller 310 (e.g., on/off, positive/negative airflow, air pressure)in accordance with the combined respiratory therapy prescription. Theservo control module 368 operates a control circuit to control theoperation of a air supply 362 (e.g., a compressor), which, in someembodiments, may provide airway clearance therapy such as intrapulmonarypercussive ventilator (IPV) through a continuous high-frequencyoscillation (CHFO) device 364. valve 366, and moisture generator 345(e.g., a nebulizer) to the nasal patient interface 322.

The patient interfaces 322, 324 are connected to the air supply 328 viathe manifolds 332, 330, respectively. The air circuit 340 for thepositive-pressure airflow patient interface 322 also includes an airflowsensor 334, a filter 336, and a moisture generator 338, to ensure thatair supplied to the patient via the nose is clean, at the correctpressure vis a vis the combined respiratory therapy prescription, andsomewhat moist so as to avoid overdrying the patient's nasal passages.Similarly, the air circuit for the negative-pressure airflow patientinterface 324 includes an airflow sensor 342 and a filter 344. Theairflow sensors 334, 342 and a pressure sensor 346 sense airflow and airpressure, respectively, in their corresponding circuits and provideairflow and air pressure data to a safety monitoring module 370. Thesafety monitoring module 370 monitors the air circuits for theoccurrence of any malfunctions and to ensure that the respiratorytherapy is being provided in accordance with the patient's combinedrespiratory therapy prescription. In some embodiments, the sensors 334,342, 346 are used to synchronize the operation of the device 110 (e.g.,the timing of the application of positive or negative pressure) with thepatient's normal breathing pattern as described above. For example, thesensor 346 may detect initiation of a breath by the patient based on thechange in air pressure in the air circuit 340, and initiate theinspiratory phase of a cough cycle, lung volume recruitment therapy, orlung ventilation therapy in response. As noted above, in the illustratedembodiment, the air circuits that supply air to the positive-pressureairflow patient interface 322 and the negative-pressure airflow patientinterface 324, including the tubing connecting the interfaces 322, 324to their respective air manifolds 332, 330, are separated from oneanother.

FIGS. 6-9 illustrate device control algorithms that can be implementedby the system 100 to change various aspects of the patient's combinedrespiratory therapy prescription and its execution by the combinationdevice 110, in real time (e.g., while the patient is receivingrespiratory care). Using the problem-first module 140, for example, theuser (e.g., a clinician, caregiver, patient, or family member, as thecase may be) can input information about the patient's currentrespiratory condition, such as “patient can't cough up secretions.” Thedevice control module 140 automatically implements therapy adjustmentsbased on the input according to defined algorithms, and then queries theuser to determine whether the adjustments were effective. If the useranswers that the adjustment didn't help the patient's condition, thesystem 100 will proceed to the next step in the algorithm as describedbelow with reference to FIGS. 6-9. If the user responds that theadjustment was effective, the system 100 will continue providing therapyaccording to the current settings, without making any additionalchanges.

Referring now to FIG. 6, an illustrative method 600 executable ascomputerized programs, routines, logic and/or instructions by the devicecontrol module 140 and/or one or more of the other modules of the system100 to, in real time, adjust a patterning-spacing aspect of thepatient's combined respiratory therapy prescription, eitherautomatically or in response to user input, is shown. In this example,the system 100 detects (either automatically based on sensor data orthrough analysis of user input) that the “patient can't cough upsecretions.” The method 600 starts operating at the patterning (e.g.,24-hour timeline) level at block 610, and, at block 612, determines(e.g., automatically or by issuing a query to the user) the spacing ofthe patient's various therapies over the course of the therapy timeline.For instance, at block 612, the method 600 determines how much timecurrently elapses between the patient's cough assistance treatmentsessions while the patient is awake (e.g., are there more than fourhours between each session?). If the answer is yes, the method 600updates the patient's prescription to change the spacing of the coughassistance treatment sessions during the patient's waking hours to occurevery four hours (e.g., to increase the frequency of the treatmentsessions), at block 614. If the answer is no that means that the patientis already receiving cough assistance therapy at least every four hourswhile awake. At block 616, the method 600 determines whether the spacingbetween treatment sessions is more than two hours but less than or equalto four hours, while the patient is awake. In other words, is theinterval between treatment sessions more than two hours but not morethan four hours? If the answer is yes, the method 600 updates thepatient's combined respiratory therapy prescription so that the coughassistance treatment sessions occur every two hours, at block 618 (e.g.,to increase the frequency of the treatment sessions). If the answer isno, then the method 600 maintains the current frequency of coughassistance treatment sessions (deduced as being less than or equal totwo hours), at block 620.

Referring now to FIG. 7, an illustrative method 700 executable ascomputerized programs, routines, logic and/or instructions by the devicecontrol module 140 and/or one or more of the other modules of the system100 to, in real time, adjust a therapy layering aspect of the patient'scombined respiratory therapy prescription, is shown. Whereas the method600 can be used to adjust the frequency of respiratory treatmentsessions over the course of a period of time, the method 700 is directedto determining whether the particular combination device 110 being usedby the patient should be changed. At block 710, the layering changesalgorithm starts, either automatically or in response to input from auser indicating, for example, a clinical change in the patient's healthcondition.

At block 712, the method 700 determines (again, either automatically orbased on user input) which features of the combination device 110 thepatient is presently using, or which combination device 110 from thefamily of combination devices described above is currently in use. Forexample, the method 700 may determine whether the patient is alreadyreceiving mucus mobilization therapy in addition to mucus extractiontherapy and either lung volume recruitment therapy (via the combinationdevice 224, for example) or lung ventilation (via the combination device226, for example). If the answer is yes, then the method 700 continuesproviding the current therapy without any changes, at block 714. If theanswer is no, then at block 716 the method 700 automatically adds mucusmobilization therapy to the patient's combined respiratory therapyprescription, or instructs the user to do so. This may be accomplishedby, for example, activating the air pulse patient interface 128 of thepatient's existing combination device 110 or switching the patient to adifferent combination device (e.g. device 228 or device 230).

Further at block 716, the method 700 updates the patient's combinedrespiratory therapy prescription to add a ten-minute mucus mobilizationtherapy session before each scheduled cough assistance treatmentsession. At block 718, the method 700 determines if the patient isalready receiving mucus mobilization therapy using a combination device110 that is also providing lung volume recruitment therapy to thepatient (e.g., device 230). If the patient is already receiving mucusmobilization therapy with lung volume recruitment therapy, then themethod 700 displays a message suggesting that the user switch thepatient to a device 110 that can provide lung ventilation therapy (inplace of the lung volume recruitment therapy) as well as the mucusmobilization therapy (e.g., device 228), at block 720. If the answer isno (meaning that the patient is already receiving both mucusmobilization and lung ventilation therapy), then at block 722 the method700 displays a message suggesting that the patient continue using thesame device 110 without any changes.

Referring now to FIG. 8, an illustrative method 800 executable ascomputerized programs, routines, logic and/or instructions by the devicecontrol module 140 and/or one or more of the other modules of the system100 to, in real time, adjust a patterning-duration aspect of thepatient's combined respiratory therapy prescription, is shown. Whereasthe method 600 may be used to adjust the spacing or time intervalbetween treatment sessions over the course of a respiratory care period(e.g., timeline), the method 800 can be used to, automatically or inresponse to user input, adjust the length or duration of individualtreatment sessions in the patient's prescription. At block 810, thepatterning duration change algorithm begins, in response to the system100 determining, for example, a clinical change in the patient'scondition. At block 812, the method 800 determines whether the treatmentsessions currently defined in the patient's combined respiratory therapyprescription are shorter in duration than fifteen minutes. If so, themethod 700 adjusts the patient's combined respiratory therapyprescription to increase the duration of the treatment sessions tofifteen minutes, at block 814. If not, the method 700 does not make anychanges to the existing specifications for the duration of the patient'streatment sessions, leaving them at the current duration of fifteenminutes or longer. At block 818, the method 800 determines whether thepatient is receiving either lung ventilation or lung volume recruitmenttherapy after each treatment session for at least fifteen minutes. Ifso, the method 800 maintains the current settings for lung ventilationor lung volume recruitment, as the case may be. If not, the method 700adjusts the patient's combined respiratory therapy prescription toincrease the duration of the patient's lung ventilation or lung volumerecruitment therapy to fifteen minutes.

Referring now to FIG. 9, an illustrative method 900 executable ascomputerized programs, routines, logic and/or instructions by the devicecontrol module 140 and/or one or more of the other modules of the system100 to, in real time, adjust a sequencing aspect of the patient'scombined respiratory therapy prescription, is shown. That is, the method900 is directed to adjusting specific details of cough assistancetreatment sequences in response to, for example, clinical changes in thepatient's condition, which the system 100 may detect automatically orreceive via user input. The method 900 begins at block 910, in responseto determining that the patient is having difficulty clearing chestsecretions on his or her own. At block 912, the method 900 determineswhether the treatment sequences in the patient's current combinedrespiratory therapy prescription already include four assisted coughcycles followed by at least two minutes of assisted ventilation. If yes,then at block 914 the method 900 continues the therapy according to theexisting prescription without making any changes. If no, then at block916 the method 900 adjusts the patient's existing respiratoryprescription to include four cough cycles followed by two minutes ofassisted ventilation.

At block 918, the method 900 determines whether the inspiratory pressureused in the cough cycle is less than 30 centimeters (cm) water (e.g.,delivered via the nasal patient interface 322). If no (meaning that theinspiratory pressure is already at least 30 cm water), then the method900 continues the therapy according to the existing prescription withoutmaking any changes, at block 920. If yes, the method 900 increases theinspiratory pressure by 1 cm water for each of the next three treatmentsessions (e.g., to a maximum of 33 cm water), at block 922. At block924, the method 900 checks to see if the expiratory pressure (in thiscase, to the mouth) during the assisted cough cycles is less than −40 cmwater (suction). If not (meaning the expiratory pressure is already atleast −40 cm water), the method 900 continues the therapy according tothe existing prescription without making any changes, at block 926. Ifyes, the method 900 updates the patient's prescription to increase theexpiratory pressure by two cm water for each of the next three treatmentsessions (e.g., to a maximum of −46 cm water). At block 930, the method900 determines whether the patient's treatment sessions are currentlydefined to include at least five treatment sequences. If yes, the method900 continues the therapy according to the existing prescription withoutmaking any changes. If no, the method 900 updates the patient'sprescription to increase the number of consecutive treatment sequencesin each treatment session to five.

Referring now to FIG. 10, an illustrative method 1000 executable ascomputerized programs, routines, logic and/or instructions by thecontrol module 120 and/or one or more of the other modules of the system100 to, in real time, operate the combination device 110 to provide theappropriate respiratory therapy to the patient at the appropriate times,is shown. At block 1010, the method 1000 monitors the clock time todetermine whether to start a portion of the patient's therapy, accordingto the patient's combined respiratory therapy prescription. For example,if the patient's prescription indicates that a treatment session is tobegin at 8:00 a.m., the method 1000 compares the current clock time tothe start time, 8:00 a.m., and when the comparison is successful,proceeds to block 1012. If no therapy is scheduled to begin at thecurrent clock time, according to the patient's prescription, then themethod 1000 simply continues to monitor the clock time at block 1010.

At block 1012, the method 1000 determines the type of therapy that itneeds to initiate using the combination device 110. If the therapy typeis mucus extraction, then at blocks 1014 and 1018, the method 1000initiates a treatment sequence, which illustratively includes a numberof consecutively executed cough cycles. If the therapy type is somethingother than mucus extraction, then the method 1000 initiates theprovision of therapy at block 1016 by configuring the settings of thecombination device 110 for the therapy in accordance with the patient'sprescription (e.g., therapy pressures, duration, etc.), and performs thetherapy at block 1036, for the prescribed period of time. While thetherapy is in progress, at block 1036, the system 100 may receive inputsfrom the user (e.g., a clinician, a caregiver, the patient, or a familymember), at block 1038 and adjust the device settings according to theinput, at block 1040. For example, the patient may wish to reduce theinspiratory or expiratory pressure and signal the device 110 to do sousing the finger switch 380 described above. The method 1000 monitorsthe time elapsed during the performance of the therapy at block 1036,and at block 1042 determines whether it is time for the therapy toconclude (based on the therapy duration specified in the patient'srespiratory prescription). If the requisite amount of time has elapsed,the method proceeds to block 1052 and ends the therapy session. If not,the method returns to block 1036 and continues the current therapy.

Returning to block 1014, the difference between the treatment sequencesand other types of therapy is that the duration of a treatment sequenceis based at least in part on the number of repetitions of the prescribedcough cycle, rather than on clock time. Thus, for treatment sequences,the method 1000 keeps track of the number of treatment sequences thathave already been performed in the current treatment session. So, atblock 1018, the treatment sequence counter is initially set to zero.Once a treatment sequence is initiated at block 1018, the methodproceeds to configure the combination device 110 for the mucusextraction therapy and for the number of cough cycles specified in thepatient's prescription, at block 1020. At block 1022, the method 1000begins performing the mucus extraction therapy (e.g., by providing thenumber of cough cycles specified in the prescription). As the treatmentsequence specifies that the cough cycles are followed substantiallyimmediately by a short period of either lung volume recruitment or lungventilation therapy, the method 1000 configures the combination device110 to provide the lung volume recruitment therapy or lung ventilationtherapy upon the completion of the cough cycle, at block 1024, andperforms the lung volume recruitment or lung ventilation therapy, atblock 1026. To do so, the method 1000 changes the pressure settings fromthose used for mucus extraction therapy to those that are appropriatefor lung volume recruitment or lung ventilation therapy.

Upon completion of the lung volume recruitment therapy or lungventilation therapy (e.g., upon expiration of the time for providingthat therapy, or therapy duration), the method 1000 marks the end of acompleted cough assistance treatment sequence, at block 1028, andincrements the number of treatment sequences, at block 1030. At block1032, the method 1000 compares the current number of treatment sequences(e.g., the treatment sequence counter value) to the total number oftreatment sequences to be performed during the therapy session, asspecified in the patient's combined respiratory therapy prescription. Ifthe value of the treatment sequence counter equals the total number oftreatment sequences to be performed during the therapy session, then thetherapy session had been completed and the method 1000 proceeds to block1034 where it resets the treatment sequence counter to zero, and thenends the therapy session, at block 1052. If the value of the treatmentsequence counter is less than the total number to be performed duringthe therapy session, then the method returns to block 1022 to performanother treatment sequence. As with the other forms of therapy, thetreatment sequences may be interrupted and modified by user input inreal time. This is illustrated by the loops 1044, 1046 and 1048, 1050,each of which operates in a similar manner to the loop 1038, 1040described above. As such, the description will not be repeated here. Atblock 1052, the method 1000 returns back to the beginning, block 1010,to continue monitoring the clock time for the start of the next therapythat is to occur according to the patient's combined respiratory therapyprescription.

In the foregoing description of the methods 600, 700, 800, 900, and1000, references may be made to the method or the system 100“determining,” “checking,” “asking the user,” etc. It should beunderstood that whenever a method or another aspect of the system 100 isexecuting computer logic, the required inputs may be received from auser, calculated automatically, or accessed from a storage location incomputer memory. For example, if an illustrative method described hereinindicates that the method asks the user for input, it should beunderstood that other embodiments may not require such user input, andinstead may obtain the needed information from, for example,calculations or by accessing a stored database or lookup table.Likewise, illustrative methods described herein as “determining” certainthings may do so by obtaining user input, accessing stored information,or performing calculations, as needed. Further, in the illustrativemethods 600, 700, 800, 900, and 1000, and in other examples describedherein, specific values are mentioned (e.g., air pressures, timedurations, etc.). It should be understood that such values are providedfor illustration purposes only, and that this disclosure is not limitedthereby.

Referring now to FIG. 11, an exemplary computing environment 1100 inwhich the system 100 may be implemented is shown. Whereas FIG. 3illustrates an embodiment in which all of the features of the system 100may be accessible directly at the combination device 110, FIG. 11illustrates an embodiment in which some of the features of the system100 may be provided on other devices. Even so, while the computingenvironment 1100 is shown as involving multiple components and devices,it should be understood that in some embodiments, the computingenvironment 1100 may constitute a single computing device (e.g., ahospital computer, or a mobile computing device) in combination with thedevice 110 and/or other devices. In other words, as used herein, theterms “system” and “environment” may refer to a single computing deviceor a combination of computing devices and/or other components.

The illustrative computing environment 1100 includes a physiciancomputing device 1110, a therapist computing device 1130, a patientcomputing device 1150, and one or more other computing devices 1170,which are in electronic communication with each other, with othercomputing devices or systems 1170, and with the combination respiratorytherapy device 110, via one or more electronic communication networksand/or telecommunications networks 1180. Each of the devices 1110, 1130,1150 is configured to use a variation of the system 100 that isappropriate for the type of user. For example, in some embodiments,various permissions and access controls may be selected for each type ofuser when the system 100 is initially set up or as new users are added.

Illustratively, the prescription creator module 112 resides on thephysician computing device 1110, and portions 118A, 118B, 118C of thecombined respiratory therapy prescription database 118 are stored oneach of the computing devices 1110, 1130, 1150, respectively. Thedifferent portions 118A, 118B, 118C of the database 118 may each includesubsets of the database 118. For example, the portions 118A and 118B mayinclude the prescriptions for only those patients under the care of theparticular physician or therapist using the devices 1110, 1130, and theportion 118C may contain only the prescription for the particularpatient using the device 1150. Similarly, portions 136A, 136B, 136C ofthe data sharing module 136, portions 140A, 140B, 140C of the devicecontrol module 140, and portions 122A, 122B, and 122C of theprescription translator module 122 may be configured specifically forthe user of the corresponding computing device 1110, 1130, 1150. Forexample, the data sharing portion 136A and the device control portion140A may include an extended set of features and capabilities, while thedata sharing portions 136B, 136C and the device control portions 140B,140C may include more limited functionality, based on the intended usersof the respective computing devices 1110, 1130, 1150. The prescriptiontranslation portions 122A, 122B, 122C may each have the same or similarfunctionality, or, in some embodiments, the portion 122A may havegreater prescription translation capabilities than the portions 1226 or122C, for example. As shown, the audio interface 142 and the personaconfiguration module 144 reside on the patient computing device 1150.However, as discussed above, portions or variations of these modules142, 144 may be adapted for use by other users, such as physicians ortherapists, and those portions or alternative versions may reside on oneor both of the physician computing device 1110 and the therapistcomputing device 1130, respectively.

In some embodiments, the computerized modules of the system 100 areembodied as a downloadable software application or “app,” which can beobtained from a centralized storage location on a network (such as aprivate hospital or home care company “app store” or “app market”). Inthese embodiments, there may be a single app that is downloadable by alltypes of users, which is then configured for the particular user onceinstalled on the user's local computing device. Alternatively, an appstore may provide different downloadable apps for different user types,so that the user may select and download the app that contains thefunctionality needed by that user. For example, one app may contain theprescription creator module 112 while another app may contain the audiointerface and persona configuration modules 142, 144 but not theprescription creator module 112. Of course, permissions and accesscontrols for downloading the apps may be set by an authorized personsuch as a hospital system administrator.

Each of the illustrative computing devices 1110, 1130, 1150 includes atleast one processor 1112, 1132, 1152 (e.g. a microprocessor,microcontroller, digital signal processor, etc.), memory 1114, 1134,1154, and an input/output (I/O) subsystem 1116, 1136, 1156. Thecomputing devices 1110, 1130, 1150 may be embodied as any type ofcomputing device such as server, an enterprise computer system, anetwork of computers, a combination of computers and other electronicdevices, a personal electronic device such as a mobile, portable, orhandheld computing device, smart phone, personal digital assistant,laptop computer, tablet computer, or desktop computer.

Although not specifically shown, it should be understood that the I/Osubsystems 1116, 1136, 1156 typically include, among other things, anI/O controller, a memory controller, and one or more I/O ports. Theprocessors 1112, 1132, 1152 and the I/O subsystems 1116, 1136, 1156 arecommunicatively coupled to the memory 1114, 1134, 1154. The memory 1114,1134, 1154 may be embodied as any type of suitable computer memorydevice (e.g., volatile memory such as various forms of random accessmemory). In the illustrative environment 1100, the I/O subsystems 1116,1136, 1156 are communicatively coupled to a number of hardwarecomponents including various input devices 1018, 1140, 1158 (e.g., atouchscreen, microphone, physical keyboard or keypad, button, or hardpanel control), at least one data storage 1126, 1146, 1166, variousoutput devices 1120, 1140, 1160 (e.g., an LED, display screen, speaker),one or more other peripheral devices 1122, 1142, 1162 (e.g., sound,graphics or media adaptors), and one or more network interfaces 1124,1144, 1164.

The data storage 1126, 1146, 1166 may include one or more hard drives orother suitable data storage devices (e.g., flash memory, memory cards,memory sticks, and/or others). In some embodiments, portions of theprescription database 118A, 118B, 118C reside at least temporarily inthe data storage 1126, 1146, 1166. Portions of the prescription database118A, 118B, 118C may be copied to the memory 1114, 1134, 1154 duringoperation, for faster processing or other reasons. Further, in someembodiments, portions of any of the software modules of the system 100may be stored in the data storage 1126, 1146, 1166 and loaded to thememory at runtime.

The network interfaces 1124, 1144, 1164 may communicatively couple thecomputing devices 1110, 1130, 1150 one or more networks 1180. Such othernetworks may include a local area network, wide area network, enterprisecloud, and/or the Internet, for example. Accordingly, the networkinterfaces 1124, 1144, 1164 may include a wired or wireless Ethernet,mobile/cell network, WI-FI, BLUETOOTH, VPN (Virtual Private Network), orNFC (Near Field Communication) device or adapter as may be needed,pursuant to the specifications and/or design of the particular network1180.

Each of the other computing devices/systems 1170 may be embodied as anysuitable type of computing device such as, for example, a server, anenterprise computer system, a network of computers, a combination ofcomputers and other electronic devices, a mobile device, any of theaforementioned types of electronic devices, or other electronic devices.For example, in some embodiments, the other computing devices 1170 mayinclude other computers or computer systems of a hospital or otherhealthcare facility, which run enterprise-type software applicationssuch as electronic medical records (EMR) systems 1172, admission,discharge, and transfer (ADT) systems 1174, and healthcare communicationsystems (e.g., nurse call systems) 1176. Thus, in some embodiments, thesystem 100 may communicate with one or more of the systems 1172, 1174,1176. For example, if a patient undergoing combined respiratory therapyusing the device 110 has a clinical change in his or her healthcondition that requires medical attention, the system 100 maycommunicate an alert to the responsible nurse or therapist via thehealthcare communication system 1176. As another example, the system 100may obtain data about the patient's medical history or history ofprevious treatments from the electronic medical records system 1172 anduse that information to configure or adjust the patient's currenttherapy prescription. Additionally, the system 100 may interface with ahealthcare facility's admission, transfer and discharge system 1174 to,for example, automatically send the patient's combined respiratoryprescription to a remote computing device upon the patient's dischargefrom the facility.

The computing environment 1100 may include other components,sub-components, and devices not illustrated in FIG. 11 for clarity ofthe description. In general, the components of the computing environment1100 are communicatively coupled as shown in FIG. 11 by signal paths,which may be embodied as any type of wired or wireless signal pathscapable of facilitating communication between the respective devices andcomponents.

In the foregoing description, numerous specific details, examples, andscenarios are set forth in order to provide a more thoroughunderstanding of the present disclosure. It will be appreciated,however, that embodiments of the disclosure may be practiced withoutsuch specific details. Further, such examples and scenarios are providedfor illustration, and are not intended to limit the disclosure in anyway. Those of ordinary skill in the art, with the included descriptions,should be able to implement appropriate functionality without undueexperimentation.

References in the specification to “an embodiment,” etc., indicate thatthe embodiment described may include a particular feature, structure, orcharacteristic, but every embodiment may not necessarily include theparticular feature, structure, or characteristic. Such phrases are notnecessarily referring to the same embodiment. Further, when a particularfeature, structure, or characteristic is described in connection with anembodiment, it is believed to be within the knowledge of one skilled inthe art to effect such feature, structure, or characteristic inconnection with other embodiments whether or not explicitly indicated.

Embodiments in accordance with the disclosure may be implemented inhardware, firmware, software, or any combination thereof. Embodimentsmay also be implemented as instructions stored using one or moremachine-readable media, which may be read and executed by one or moreprocessors. A machine-readable medium may include any mechanism forstoring or transmitting information in a form readable by a machine(e.g., a computing device or a “virtual machine” running on one or morecomputing devices). For example, a machine-readable medium may includeany suitable form of volatile or non-volatile memory.

In the drawings, specific arrangements or orderings of schematicelements may be shown for ease of description. However, the specificordering or arrangement of such elements is not meant to imply that aparticular order or sequence of processing, or separation of processes,is required in all embodiments.

In general, schematic elements used to represent instruction blocks ormodules may be implemented using any suitable form of machine-readableinstruction, and each such instruction may be implemented using anysuitable programming language, library, application programminginterface (API), and/or other software development tools or frameworks.Similarly, schematic elements used to represent data or information maybe implemented using any suitable electronic arrangement or datastructure. Further, some connections, relationships or associationsbetween elements may be simplified or not shown in the drawings so asnot to obscure the disclosure.

This disclosure is to be considered as exemplary and not restrictive incharacter, and all changes and modifications that come within the spiritof the disclosure are desired to be protected. For example, whileaspects of the present disclosure may be described in connection withparticular types and features of respiratory therapy devices, it shouldbe understood that the various aspects are applicable to other types andfeatures of such devices.

1. A combined respiratory therapy device control module embodied in oneor more machine-accessible storage media and executable by a combinationrespiratory therapy device controller to: monitor a period of time overwhich a person connected to a combination respiratory therapy devicecontrolled by the combination respiratory therapy device controller isto receive combined respiratory therapy according to a combinedrespiratory therapy prescription, the combined respiratory therapyprescription defining a plurality of different therapy sessions to beperformed by the combination respiratory therapy device at differenttimes during the period of time, each of the plurality of differenttherapy sessions comprising at least a mucus extraction therapy followedsubstantially immediately by a lung ventilation therapy or a lung volumerecruitment therapy; configure the combination respiratory therapydevice to perform each of the plurality of different therapy sessions atthe appropriate times and with the appropriate device settings accordingto the combined respiratory therapy prescription; and control thecombination respiratory therapy device to perform each of the pluralityof different therapy sessions at the appropriate times with theappropriate device settings according to the combined respiratorytherapy prescription.
 2. The control module of claim 1, executable bythe combination respiratory therapy device controller to repeat themucus extraction therapy followed substantially immediately by the lungventilation therapy or lung volume recruitment therapy a predefinednumber of times during each treatment session.
 3. The control module ofclaim 1, executable by the combination respiratory therapy devicecontroller to present an audio message to the person before performingthe therapy sessions.
 4. The control module of claim 3, executable bythe combination respiratory therapy device controller to present theaudio message at a predetermined time in relation to the therapysessions.
 5. The control module of claim 4, executable by thecombination respiratory therapy device controller to configure the audiomessage for the person based on the person's age.
 6. The control moduleof claim 4, executable by the combination respiratory therapy devicecontroller to configure the audio message based on the time of day. 7.The control module of claim 1, executable by the combination respiratorytherapy device controller to configure the combination respiratorytherapy device to supply positive-pressure air flow at a first pressurefollowed positive-pressure air flow at a second pressure during the lungventilation or lung volume recruitment therapy, and configure thecombination therapy device to supply positive-pressure air flow at athird pressure greater than the first pressure followed bynegative-pressure air flow during the mucus extraction therapy.
 8. Thecontrol module of claim 1, executable by the combination respiratorytherapy device controller to configure the combination respiratorytherapy device to supply a series of air pulses prior to at least one ofthe therapy sessions.
 9. The control module of claim 1, executable bythe combination respiratory therapy device controller to receive userinput, reconfigure the combination respiratory therapy device based onthe user input, and perform a modified therapy session based on the userinput.
 10. A combined respiratory therapy system, comprising: acombination respiratory therapy device to execute a combined respiratorytherapy prescription, the combined respiratory therapy prescriptiondefining a plurality of different therapy sessions to be performed bythe combination respiratory therapy device over a period of time, eachof the plurality of different therapy sessions comprising at least amucus extraction therapy followed substantially immediately by a lungventilation therapy or a lung volume recruitment therapy; a prescriptioncreator module embodied in one or more machine-accessible storage media,the prescription creator module executable by a computing system tointeract with a physician to create the combined respiratoryprescription; and a control module embodied in one or moremachine-accessible storage media, the control module executable by thecomputing system to configure the combination respiratory therapy deviceto perform the therapy sessions according to the combined respiratorytherapy prescription.
 11. The system of claim 10, comprising a datasharing module embodied in one or more machine-accessible storage media,the data sharing module executable by the computing system toelectronically communicate the combined respiratory therapy prescriptionto the combination respiratory therapy device.
 12. The system of claim11, wherein the data sharing module is executable by the computingsystem to electronically communicate the combined respiratory therapyprescription to another computing device.
 13. The system of claim 11,wherein the data sharing module is executable by the computing system todisplay at least a portion of the combined respiratory therapyprescription at another computing device used by healthcare personnel.14. The system of claim 11, wherein the data sharing module isexecutable by the computing system to electronically communicate atleast a portion of the combined respiratory therapy prescription from aremote computing device used by healthcare personnel to the combinationrespiratory therapy device.
 15. The system of claim 11, wherein the datasharing module is executable by the computing system to display at leasta portion of the combined respiratory therapy prescription at anothercomputing device used by a person receiving the combined respiratorytherapy.
 16. The system of claim 11, wherein the data sharing module isexecutable by the computing system to electronically communicate atleast a portion of the combined respiratory therapy prescription from acomputing device used by a person receiving the combined respiratorytherapy to the combination respiratory therapy device.
 17. The system ofclaim 11, wherein the data sharing module is executable by the computingsystem to enable two-way electronic communication of at least a portionof the combined respiratory therapy prescription between or among aplurality of computing devices used by a plurality of healthcarepersonnel.
 18. A control unit for a combination respiratory therapydevice, comprising: an air supply; a first air circuit operably coupledto the air supply to supply positive-pressure air flow to a positive airflow patient interface of the combination respiratory therapy device; asecond air circuit operably coupled to the air supply to supplynegative-pressure air flow to a negative air flow patient interface ofthe combination respiratory device; the second air circuit beingphysically separate from the first air circuit; a controller to controlthe air supply; and memory accessible by the controller, the memorycomprising instructions executable by the controller to: activate theair supply to supply air to the first air circuit at a first positivepressure during a ventilation or lung volume recruitment portion of arespiratory therapy treatment session; and alternatingly activate theair supply to supply air to the first air circuit at a second positivepressure greater than the first positive pressure followed by a supplyof air to the second air circuit at a negative pressure during acoughing assistance portion of the respiratory therapy treatmentsession.
 19. The control unit of claim 18, comprising another air supplyand a third air circuit operably coupled to the other air supply tosupply a series of air pulses to an air pulse patient interface of thecombination respiratory therapy device.
 20. The control unit of claim19, wherein the third air circuit is physically separate from at leastthe second air circuit.
 21. The control unit of claim 19, wherein thethird air circuit is physically separate from the first air circuit andthe second air circuit.
 22. The control unit of claim 19, wherein theair pulse patient interface is selectively coupled to the positive airflow patient interface.
 23. The control unit of claim 18, comprising acontrol panel to input patient condition information, wherein thecontrol unit is configured to adjust the operation of the air supply inreal time based on the patient condition information.
 24. The controlunit of claim 18, wherein the positive air flow patient interface onlysupplies positive air flow nasally and the negative air flow interfaceonly supplies negative air flow orally.
 25. The control unit of claim18, comprising one or more sensors in communication with the controllerto align the positive air flow with a person's normal breathing patternduring both the coughing assistance portion and the ventilation portionof the respiratory therapy treatment session.
 26. A system forcombination respiratory therapy, comprising the control unit of claim18, the positive air flow patient interface, and the negative air flowpatient interface.
 27. The system of claim 26, wherein the control unitis in selective communication with an air pulse patient interface. 28.The system of claim 27, wherein the instructions are configured toselectively provide, during the respiratory therapy treatment session:(i) mucus extraction therapy followed by lung ventilation therapy; or(ii) mucus extraction therapy followed by lung volume recruitmenttherapy; or (iii) mucus mobilization therapy followed by mucusextraction therapy followed by lung ventilation therapy; or (iv) mucusmobilization therapy followed by mucus extraction therapy followed bylung volume recruitment therapy.
 29. The system of claim 26, comprisinga network interface to receive user input relating to a patient'scondition from another device.
 30. The system of claim 26, comprising agraphical user interface to create or modify the respiratory therapyprescription, the graphical user interface being located at thecontroller.
 31. The system of claim 26, comprising an audio userinterface to provide audio messages to a person using the combinationrespiratory therapy device.